Intestinal-type adenocarcinoma

McCluggage WG, Shah R, Cormolly LE, McBride HA. Intestinal-type cervical adenocarcinoma in sim and adenocarcinoma exhibit a partial enteric immunophenotype with consistent expression of CDX2. Int J Gynecol Pathol. 2008 27 92-100. 

TABLE 9.9 1 Intestinal-type Adenocarcinoma versus Metastatic Adenocarcinoma of Colon ... 

Intestinal-type adenocarcinomas (ITACs) are rare tumors of the sinonasal tract that bear a remarkable histologic resemblance to tumors arising in the intestines. Rare cases can even resemble normal small intestinal mucosa. There is an epidemiologic linkage to occupational exposure to wood dust, particularly the hard woods, as found in furniture making. ITAC is more common in males by a ratio of 4 1 and occurs over a broad age range, with an average of 58 years. 

Intestinal-type adenocarcinomas resemble colorectal carcinomas at the histologic level. 

Ozolek JA, Barnes EL, Hunt JL. Basal/myoepithelial cells in chronic sinusitis, respiratory epithelial adenomatoid hamartoma, inverted papilloma, and intestinal-type and nonintesti-nal-type sinonasal adenocarcinoma an immunohistochemical study. Arch Pathol Lab Med. 2007 131(4) 530-537. 

Barnes L. Intestinal-type adenocarcinoma of the nasal cavity and paranasal sinuses. Am J Surg Pathol. 1986 10(3) 192-202. 

McKinney CD, Mills SE, Franquemont DW. Sinonasal intestinal-type adenocarcinoma immunohistochemical profile and comparison with colonic adenocarcinoma. Mod Pathol. 1995 8(4) 421-426. 

Amre R, Ghali V, Elmberger GEA. Sinonasal intestinal-type adenocarcinomas (SNITAC) An immunohistochemical (IHC) study of 22 cases. Mod Pathol. 2004 17 221 A (Abstract). 

Resto VA, Krane JF, Faquin WC, et al. Immunohistochemical distinction of intestinal-type sinonasal adenocarcinoma from metastatic adenocarcinoma of intestinal origin. Ann Otol Rhinol Laryngol. 2006 115(l) 59-64. 

Kennedy MT, Jordan RC, Berean KW, et al. Expression pattern of CK7, CK20, CDX-2, and villin in intestinal-type sinonasal adenocarcinoma. / Clin Pathol. 2004 57(9) 932-937. 

Huang W, Zhao), Li L, et al. a-Methylacyl coenzyme A racemase is highly expressed in the intestinal-type adenocarcinoma and high-grade dysplasia lesions of the stomach. Histol Histopathol. 2008 23 1315-1320. 

In contrast, only up to 33% of colorectal mucinous adenocarcinomas are MUC5A positive.Similar to colorectal mucinous adenocarcinomas, appendiceal mucinous tumors diffusely and strongly stain with cytokeratins 8, 13, 18, 19, 20, MUC2, CDX2, and DPC4.i °492,196,197 Nonmucinous, intestinal-type adenocarcinomas of the appendix are rare and are immu-nophenotypically similar to colonic adenocarcinomas. 

FIGURE 15.24 Intestinal-type ampullary adenocarcinomas are diffusely immunoreactive for CDX2 (A). In contrast, pancreatobiliary-type ampullary adenocarcinomas either are negative (B) or exhibit only focal CDX2. 

Endocrine cells are commonly found in ampullary adenocarcinomas. Although they may not be evident by routine microscopy, immunohistochemical staining for chromogranin reveals scattered endocrine cells in one third of the cases. The distribution of these neuroendocrine cells is random in some cases they are scattered evenly throughout the tumor, whereas in others they may be clustered. In general, they are more common in intestinal-type or mucinous adenocarcinomas than in pancreatobiliary type. ... 

Mutations of p53 have been detected in the majority of ampullary carcinomas with corresponding accumulation of the abnormal product as detected immunohistochem-ically." " EGFR is overexpressed in 50% to 65% of invasive ampullary carcinomas. Pancreatobiliary-type adenocarcinomas are more likely to overexpress EGFR than are intestinal-type tumors. Related growth factors c-erbB-2 and c-erbB-3 are also overexpressed in ampullary carcinoma. 

CK7 is often strongly positive and CK20 more focal in pancreatobiliary-type ampullary adenocarcinomas, whereas intestinal-type ampullary adenocarcinomas tend to have more CK20 and less CK7. 

Spread from a colonic or rectal primary could present a diagnostic challenge in bladder transurethral resection (TUR) samples. In fact, such secondary involvement is a more common occurrence than primary adenocarcinoma of the bladder. Differentiating a CRCa spread from intestinal-type primary adenocarcinoma of bladder cannot usually be made with certainty. The presence of a background of urothelial intestinal metaplasia with associated glandular dysplasia may favor a primary origin however, one should consider the possibility of secondary colonization of bladder urothelial mucosa by a... 

Intestinal-type endocervical adenocarcinoma and AIS contain goblet cells and intestinal type epithelium and may be mistaken for spread of primary intestinal adenocarcinoma. The intestinal marker CDX2 is expressed in intestinal type endocervical adenocarcinoma and AIS as well as in some non-intestinal types (Fig. 18.10). Therefore CDX2 does not help define site of origin. Instead, CK7, CK20, and pl6 should be used. Whereas primary endocervical adenocarcinoma expresses CK7 and pl6 but not CK20, the converse... 

FIGURE 18.10 Intestinal-type endocervical adenocarcinoma with prominent goblet cells (A) (H E) may resemble primary intestinal adenocarcinomas that spread to the cervix. CDX2 (B) is expressed in the nuclei of this variant of endocervical adenocarcinoma and therefore should not be used to determine site of origin. CK7, CK20, and pi 6 should be used instead. 

Overexpression of ErbB-2 is associated with a decreased disease-free survival in intestinal-type adenocarcinoma of the paranasal sinuses (Gallo et al, 1998), palatal salivary gland neoplasms (Giannoni et al, 1995), and mucoepidermoid carcinoma of the salivary gland (Press et al, 1994). 

Studies on the association of H. pylori with gastric cancer start with a report in 1991, which described the higher seram titer for H. pylori in patients who developed gastric adenocarcinoma in a prospective study. There are basically two kinds of gastric adenocarcinoma well-differentiated (intestinal type) and poorly differentiated (diffuse type). In a Japanese study that focused on early gastric cancer, the odds for serum positivity were higher in well-differentiated adenocarcinoma than in poorly differentiated adenocarcinoma. 

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